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Double-blind optimization of subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot
Rajamannar Ramasubbu1, Susan Anderson, Angela Haffenden
1Department of Psychiatry and Clinical Neurosciences, Faculty of Medicine, University of Calgary, Hotchkiss Brain Institute, Calgary, Alta., Canada. rramasub@ucalgary.ca
Journal of Psychiatry & Neuroscience : JPN
|March 27, 2013
Summary
Longer pulse widths in deep brain stimulation (DBS) for treatment-resistant depression (TRD) improved mood and reduced depressive symptoms. Further research is needed to determine optimal stimulation parameters for subcallosal cingulate DBS.
Area of Science:
- Neuroscience
- Psychiatry
- Neurosurgery
Background:
- Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) shows promise for treatment-resistant depression (TRD).
- Optimal electrical stimulation parameters for SCC-DBS remain undetermined, often relying on trial and error.
- This pilot study aimed to investigate the relationship between stimulus parameters and clinical outcomes in SCC-DBS for TRD.
Observation:
- Four TRD patients underwent SCC-DBS surgery.
- A double-blind phase involved weekly alterations in stimulation frequency and pulse widths, with mood and depression assessed via VAS and HAM-D-17.
- An open-label phase evaluated depressive symptoms biweekly for six months.
Findings:
- Longer pulse widths (270-450 μs) correlated with reduced HAM-D-17 scores in three patients and enhanced mood in all four.
- Altering stimulation frequency had minimal acute effects on mood or depression.
- After six months, two patients responded, and one partially responded to open-label therapy.
Implications:
- Longer pulse width stimulation may be crucial for optimizing SCC-DBS in TRD.
- Current understanding of optimal target and stimulus parameters for SCC-DBS is limited, potentially due to current spread.
- Further investigations into varied stimulus parameters are necessary before large-scale randomized controlled trials.
